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From the 10/15/2021 release of VAERS data:

This is VAERS ID 1165545



Case Details

VAERS ID: 1165545 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-02-05
Onset:2021-03-12
   Days after vaccination:35
Submitted: 0000-00-00
Entered: 2021-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ6136 / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Gastric haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal haemorrhage (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-12
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Factor V Leiden mutation
Allergies:
Diagnostic Lab Data:
CDC Split Type: NLPFIZER INC2021342669

Write-up: died of likely stomach bleeding; This is a spontaneous report from a contactable consumer downloaded from the Agency Regulatory Authority-WEB, regulatory authority number NL-LRB-00482618. An 86-year-old male patient received the first dose of BNT162B2 (COMIRNATY; lot number: EJ6136), via unspecified route of administration on 05Feb2021 at a single dose for COVID-19 immunization. Medical history included Factor V Leiden mutation. The patient''s concomitant medications were not reported. On 12Mar2021 (also reported as one week after vaccination), the patient died of likely stomach bleeding. The patient died on 12Mar2021. It was not reported if an autopsy was performed. Reporter''s Comments: BioNTech / Pfizer vaccine (Comirnaty). Past drug therapy BioNTech / Pfizer vaccine (Comirnaty): no. Died 1 week after vaccination (also reported as stomach hemorrhage: 1 month after start). Confounding factors: Factor V Leiden.; Reporter''s Comments: BioNTech / Pfizer vaccine (Comirnaty). Past drug therapy BioNTech / Pfizer vaccine (Comirnaty): no. Died 1 week after vaccination (also reported as stomach hemorrhage: 1 month after start). Confounding factors: Factor V Leiden.; Reported Cause(s) of Death: died of likely stomach bleeding


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